Final Word | October 2014 Hearing Review
By Dennis Van Vliet, AuD
It was probably sometime in the early 1980s. I was seeing patients in a hospital audiology clinic. The patient was a nurse who performed visiting nursing services in patients’ homes. Her duties included calling for orders from the physician while she was in the homes she was visiting. At the time, cell phones weren’t around, and telephone companies owned the phones in people’s homes and dictated the technology available. Most everyone in her position could make the communication needs work—unless a hearing loss was in the equation.
The patient I was seeing had a severe hearing loss, roughly a flat 70 dB loss. With her hearing aids, she communicated very well. Without, she was effectively deaf. Fortunately, she had a solid early education, had learned how to compensate for the loss, and had been successful in nursing school. She was effective in her job.
The specific complaint she had at the initial visit with me was that the telecoil in her hearing aids did not provide the audibility and clarity she needed for the specific nature of the phone calls she made for patient management. Recall that, in the early 1980s, traditional BTEs were about 80% of the market, and most came equipped with telecoils, some better than others. Our hospital had an electroacoustic analyzer for hearing aids, but no T-coil test option. Once I had determined that the hearing aid was working appropriately for acoustic input, I had to rely on listening checks for trouble-shooting the telecoil. I happened to have a consumer device that changed acoustic energy into electromagnetic in the clinic. This device was made to work with any telephone, specifically to create an amplified electromagnetic signal.
As I pulled out the adapter device and started checking her aids, she became animated and started asking questions about what it was and how it worked. As we talked, she explained how she carried a personal telephone receiver element with her as she went from home to home, and in homes where the system wasn’t telephone compatible, she would disassemble the patient’s phone and temporarily install her personal telecoil-compatible receiver element. She was so excited to find out that there was a consumer device that would eliminate the need for her to take apart her patients’ phones. She said that they occasionally got cranky about that!
Hers was the perfect case for telecoils: severe loss, good word recognition ability, and a need for an effective coupling to telephones anywhere.
One problem was that not all phones were telecoil compatible. Another problem was interference from other electromagnetic radiation sources. Depending on where she was, the hum from a dimmer switch, an electric panel, or other source would mask out anything she wanted to hear over the phone. An effective telecoil user needs to be adaptive, and patient. The setup of microphones on or off needs to match the circumstances and the needs of the moment. Certainly, telecoils have their advantages as well as limitations. She was a good user, and bought two of the adapters on the spot that day.
Today, there are many more options for solving the telephone problem. The telecoil is still on the list, but often not the best choice. Wide-area listening with looping has merit in public places, but also isn’t without pitfalls.
The Final Word? As a clinician, I have been cautious but inclusive when considering telecoils to solve a coupling or signal-to-noise issue. I continue to have the same basic philosophy. No matter how enthusiastic we may be about a technology solution—wireless, telecoil, custom or standard form-factor, open or closed fitting—each has its place, and the solution must match the needs and capabilities of the ultimate user.
As we continue on a path to a connected world where life without Wi-Fi is considered a hardship (yes, I am writing this sitting in a beautiful island cove off the Southern California coast in a friend’s sailboat sans signal, and I am just a little anxious…), one cannot help but wonder when the time may come that telecoils will take the path of pulp newspapers, land lines, and typewriters, and head toward extinction.
Yes, telecoils are elegantly simple, and effective for some, but not for all. Let’s be thoughtful in our choices and advocacy for our patients. In the meantime, my patient who used telecoils effectively 30+ years ago now travels the world in her work and still finds a need for telecoils. But she also appreciates having other options.